FCE Grid and Test Correlations WorkWell Prevention & Care

Webinar Objectives: Participants will understand: All sections of the FCE Test Results Document (“Grid”) How to complete the FCE Grid How to correlate test items

Webinar Courtesy Your phone system may disturb all others participating in the webinar. Please DO NOT put your phone on “hold” – we will hear your music or advertising Eliminate background noises if on speaker we will hear your co-workers talking, laughing, etc.

Webinar “WorkWell’s FCE Professional Guidelines and Advanced Documentation” seminar Based on years of working as a Clinical Therapist for WorkWell Webinar is based on a portion of this seminar 8 hour seminar Interactive – discussions, questions and answers Seminars are listed in the Newsletter

“FCE Grid”

“FCE Grid” #1- Results based on specific work factors. #2 Interpretation of observed function #3 Test results

WorkWell FCE Test Results The interpretation of WorkWell’s standardized functional testing is based on assumptions including normal breaks, basic ergonomic conditions and that the tested functions are usually not required more than 2/3 of a normal working day. If a function is required continuously, job related testing should be performed.

Based on Assumptions # 1 - Normal breaks 8 hour working day (2) 15 min. breaks 30 min. to an hour for lunch Example: If working a 7:00 – 3:30 shift (8.5 hours) 2 hours work – 15 min. AM break 2 hours work - 30 min. Lunch 2 hours work - 15 min. PM break 2 hours work - Home

Based on Assumptions #2 – Basic ergonomic conditions Ergonomic Risk Factors: Repetitions Forces Awkward postures Vibration - direct contact trauma Temperature

Based on Assumptions #3 – Testing function not required more than 2/3 of the day (frequently) If an activity is required continuously 67-100% of the day, job related testing should be performed. How many activities can be performed continuously?

FCE test results (grid) Interpretation of observed function regarding activity during a normal work day. Interpretation of observed function regarding activity during a normal work day. Frequency Weighted Activities Observed Physiologic Effort Level Position/Ambulation Quantitative + Qualitative Results % of Workday Never Contraindicated Not Possible 0% Rarely Maximum Significant Limitation 1-5% Occasionally Heavy Some Limitation 6-33% Frequently Low Slight/No 34-66% Self-limited Client stopped test, submaximum effort level Submax %

FCE test results (grid) Frequency Weighted Activities Observed Physiologic Effort Level Position/Ambulation Quantitative + Qualitative Results % of Workday Timeframes in 8 hr. workday Never Contraindicated Not Possible 0% Rarely Maximum Significant Limitation 1-5% 1- 24 min. Occasionally Heavy Some Limitation 6-33% 25” - 2’ 40” Frequently Low Slight/No 34-66% 2’ 41” - 5’ 15” Self-limited Client stopped test, submaximum effort level Submax %

FCE test results (grid) Frequency Weighted Activities Observed Physiologic Effort Level Position/Ambulation Quantitative + Qualitative Results % of Workday Timeframes in 8 hr. workday Never Contraindicated Not Possible 0% Rarely Maximum Significant Limitation 1-5% 1- 24 min. Occasionally Heavy Some Limitation 6-33% 25” - 2’ 40” Frequently Low Slight/No 34-66% 2’ 41” - 5’ 15” Self-limited Client stopped test, submaximum effort level Submax %

Quantitative and Qualitative Results Quantitative – defined by test protocols Amount of weight Distance Time completed Example: Standing Work Never: Unable to perform, totally contraindicated Rare: Significant limitation < 10 min. Occasional: Some limitation 10 min. - < 30 min. Frequent: Slight / No limitation 30 min.

Quantitative and Qualitative Results Qualitative – observed objective aspects of performance Antalgic gait Frequent weight shifting Limited strength / giving way / compensates Pace Stability – compensatory movement Balance Using support

Final Score Quantitative + Qualitative Results Considerations Individual test result per protocol Magnitude of observed difficulty Based on observation Consider % of workday definitions

Review of the FCE Test Results and Interpretation - “Grid” NEVER RARELY OCC. FREQ. Lifting, Strength Lbs or kg (circle) Unable Max. Heavy Low Limitation Recommendation Waist to Floor Waist to Crown Front Carry Push (static) Pull (static) There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

FCE Grid NEVER RARELY OCC. FREQ. Posture, Flexibility, Ambulation Unable Significant Limitation Some Limitation Slight or No Limitation Limitation Recommendation Elevated Work Fwd Bend Standing Sitting Standing Work Walking 6MWT Crouch

Limitations Observation – increased lumbar lordosis and frequent weight shifting Limitation – decreased core trunk strength limited LE strength decreased hip flexibility – tight hip flexors dermatome radicular pattern L4-5 pain

Recommendations Think “ergonomics” Use of carts, ladders, dollies, wheelbarrow, etc. Frequent, short rest breaks when doing this activity Alternate job tasks to decrease duration of heavy lifting Raise work surface

FCE Grid Examples Maximum performance in a return to work FCE Client with poor outcome in a R RCR Client that Self –limits Correlating FCE Test Results

“Grid” Patient referred for return to work determinations NEVER RARELY OCC. FREQ. Lifting, Strength Lbs or kg (circle) Unable Max. Heavy Low Limitation Recommendation Waist to Floor 75 65 40 Waist to Crown 50 20 Front Carry 70 Push-Pull (Static) Force Generated Limitations Recommendations Push (static) 100 Pull (static) 120 There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

Return to work FCE Get a job description prior to testing Add job specific testing Use the job match grid

FCE Grid Patient with poor outcome from R RCR NEVER RARELY OCC. FREQ. Lifting, Strength Lbs or kg (circle) Unable Max. Heavy Low Limitation Recommendation Waist to Floor 75 65 40 Waist to Crown 15 10 Decreased R shoulder strength and ROM Use step ladders for crown or overhead work. Limit duration of working above shoulder level. Front Carry 70 Push-Pull (Static) Force Generated Limitations Recommendations Push (static) 100 Pull (static) 120

FCE Grid Patient with poor outcome from R RCR NEVER RARELY OCC. FREQ. Lifting, Strength Lbs or kg (circle) Unable Max. Heavy Low Limitation Recommendation Waist to Floor 75 65 40 Waist to Crown (hands on handles) X Decreased R shoulder strength and ROM. Unable to reach to shoulder level. . Waist to Crown (Preferred Method) 15 10 Modified to use of L arm only secondary to decreased R shoulder ROM, strength. Use a step ladder to place objects between waist and chest when lifting. Front Carry 70

FCE Grid X Posture, Flexibility, Ambulation Elevated Work NEVER RARELY OCC. FREQ. Posture, Flexibility, Ambulation Unable Significant Limitation Some Slight or No Recommendation Elevated Work X Decreased R shoulder strength and ROM. Unable to reach to shoulder level Client is able to do elevated work with L arm (see job specific testing) Fwd Bend Standing Sitting Standing Work Walking 6MWT Crouch

Patient with poor outcome from a R RCR What would you expect to read in this FCE? Diagnosis and history to support R RCR Patient reporting problems in ADL’s and work at chest level or higher Decreased ROM and Strength in the Physical Exam. Difficulty with Waist to Crown lifting, Elevated work, and any job simulation that requires working at chest level or higher

Self-limiting Client stops the test activity prior to therapist observing maximum effort. Generally due to pain or fear of reinjury Be clear in your report which tests were self-limited Watch for confliction statements Client gave maximum effort on all tests Client had limitations on some tests Client self-limited some tests

Self-limiting FCE Grid NEVER RARELY OCC. FREQ. Lifting, Strength Lbs or kg (circle) Unable Max. Heavy Low Limitation Recommendation Waist to Floor Self-limited with c/o LBP Observed ability 10# low effort. Waist to Crown (hands on handles) 20 15 5 Waist to Crown (Preferred Method) 25 Front Carry

Self-limiting FCE Grid NEVER RARELY OCC. FREQ. Posture, Flexibility, Ambulation Unable Significant Limitation Some Slight or No Recommendation Elevated Work X Decreased core trunk strength and stability Provide ladder when doing elevated work to keep objects between waist and chest height Fwd Bend Standing Client self-limited. Observed ability indicates ability to perform this activity at least rarely Sitting Client self-limited. Observed ability indicates ability to perform this activity at least occasionally. Standing Work Walking 6MWT

Correlating test items The 6MWT - walking Rare – must have an appropriate corresponding diagnosis to support this low distance. Rare = 0 -24 min. in a workday, an average of 3 min. per hour. Review protocol – must walk “fast” Frequent turns may cause a lower score Review “factors associated with a shorter 6MWT

Walking correlations If a client is limited in walking, then activities that require walking will also be limited. What other tests require walking? Carrying an object (front, L or R carries) Stairs Ladders

FCE Grid – Walking Limitations Final analysis with correlations NEVER RARELY OCC. FREQ. Lifting, Strength Lbs or kg (circle) Unable Max. Heavy Low Limitation Recommendation Waist to Floor 75 65 30 Waist to Crown 50 40 20 Front Carry 70 Client unable to carry frequently due to walking limitation Push-Pull (Static) Force Generated Limitations Recommendations Push (static) 100 Pull (static) 120 There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

FCE Grid – Walking Limitations Final analysis with correlations NEVER RARELY OCC. FREQ. Posture, Flexibility, Ambulation Unable Significant Limitation Some Slight or No Recommendation Elevated Work X Fwd Bend Standing Sitting Standing Work Walking 6MWT Antalgic gait, balance deficits. Uses a cane to ambulate

Correlations for Standing Work If a client is limited in standing work, then other activities that require this will also be limited. What other tests require standing work Waist to floor lift Waist to crown lift Short carry Forward bending – standing

Standing work Standing work is tested during the lifts and carries (30 min.) The test results may be limited due to the client being unable to tolerate the extra load imposed with lifting and carrying weight. You may restart the standing work timer after lifts and carries to determine standing work ability when weight is not involved.

FCE Grid – Standing Work Limitations Final analysis with correlations NEVER RARELY OCC. FREQ. Lifting, Strength Lbs or kg (circle) Unable Max. Heavy Low Limitation Recommendation Waist to Floor 75 65 Client unable to lift frequently due to standing work limitations Waist to Crown 50 40 Front Carry 70 20 Push-Pull (Static) Force Generated Limitations Recommendations Push (static) 100 Pull (static) 120 There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

FCE Grid – Standing Work Limitations Final analysis with correlations NEVER RARELY OCC. FREQ. Posture, Flexibility, Ambulation Unable Significant Limitation Some Slight or No Recommendation Elevated Work X Fwd Bend Standing Sitting Standing Work Decreased core trunk strength, radicular pain consistent with L4-5 HNP Walking 6MWT

Wrap Up Webinar format limits abilities for discussions Watch your newsletter for the 8 hour seminar “Advanced Documentation” If you are interested in hosting a session, please email slarue@workwell.com Include your: Name Facility City State

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